Provider Demographics
NPI:1598409799
Name:STARDUST COUNSELING INC
Entity Type:Organization
Organization Name:STARDUST COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LCPC
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAFERIN-REED
Authorized Official - Suffix:
Authorized Official - Credentials:MS NCC LCPC
Authorized Official - Phone:410-215-2589
Mailing Address - Street 1:122 OLD CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4522
Mailing Address - Country:US
Mailing Address - Phone:410-215-2589
Mailing Address - Fax:
Practice Address - Street 1:122 OLD CHURCH DR
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4522
Practice Address - Country:US
Practice Address - Phone:410-215-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty